Journal Issue: Vol. 13, No. 4 - October 2014

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Haematology Patients’ Information Needs and Experience with Late Effects of Treatment: Findings from Australia

Assoc Professor Pam McGrath

  1. Assoc Professor Pam McGrath
    Senior Research Fellow
    Centre for Community Science, rnPopulation & Social Health Program, rnGriffith Health Institute, LO5, Level 1rnLogan Campus, Griffith University

This article makes a contribution to the literature on late effects for adult on-set haematology patients by presenting findings from a major study on survivorship funded by the Leukaemia Foundation of Queensland. The qualitative study involved in-depth interviews with fifty individuals diagnosed with a haematological malignancy and one focus group. The article focus is on a subset of findings on the individual’s perception of the major late effects experienced and their attitudes and perspectives on information required about late effects at the point of treatment. The evidence from the research points to positive outcomes from treatments with many participants reporting little or no problem with late effects. However, the findings also point to major difficulties for some patients associated with late effects such as CRF (cancer-related fatigue), neuropathy, and infertility. The findings demonstrate the complexity of haematology patients’ informational needs that require active, ongoing, patient-centred understanding and care. The hope and expectation is that the findings will deepen the understanding of the experience of late effects for haematology patients and provide useful information for haematology/oncology health professionals for their important work in this area.

Solitary Sinonasal Extramedullary Plasmacytoma - A Case Report

Dr Subhashis Mitra, Dr Sanghamitra Mukherjee, Dr Hema Chakraborty

  1. Dr Subhashis Mitra
    MD (Pathology)
    Advanced Medicare and Research Institute (AMRI Hospitals)
  2. Dr Sanghamitra Mukherjee
    MD (Path)
    Advanced Medicare and Research Institute (AMRI Hospitals),
  3. Dr Hema Chakraborty
    DCP, MD (Pathology)
    Advanced Medicare and Research Institute (AMRI Hospitals)

We present a case of solitary sinonasal plasmacytoma in a 30 year old man ,presenting as nasal polyposis and diagnosed after excisional biopsy and histopathological examination. Extramedullary plasmacytoma is a rare neoplasm usually occuring in the head and neck region, primarily in the sinonasal tract.Current treatment modality of choice is surgery and radiotherapy, and prompt diagnosis is important.

Potential Use of Conventional/Crude Cannabis in Cancer Pain Control - A Retrospective Interview Based Study

Dr Attili VS Suresh, Dr Attili VS Prakash, Dr Kamireddy V Suresh Kumar, Dr Chinnababu Sunkavalli, Dr B B Ananda, Dr Anuradha Vutukuru

  1. Dr Attili VS Suresh
    Department of Medical Oncology, Apollo Hopsitals
  2. Dr Attili VS Prakash
    Department of Management studies, IIT Chennai
  3. Dr Kamireddy V Suresh Kumar
    Director, Clinsync
  4. Dr Chinnababu Sunkavalli
    Director, Clinsync, rn
  5. Dr B B Ananda
    Department of Surgery, BRA Medical College
  6. Dr Anuradha Vutukuru
    Department of Pathology, Pratima Medical College.

Background: Pain, a significant terminal symptom of Cancer, is often poorly controlled in advanced stages, despite highest dose of NSAID/opiods. In India, often, patients shift to alternate forms of medication if they find ongoing medication to be ineffective. Methods: We researched to explore list of possible medications that had potential of producing clinical benefits and attempted to establish some coherency among them. After listing and analyzing, we found that two most frequently used components in herbal medications that produced satisfactory pain control are steroids and cannabinoids. Cannabinoids, though well known are not so popular and uniformly approved across the world. The study is a retrospective interview based one, done at three tertiary cancer centers during period of August 2011- 2013. Patients with advanced cancer, not on chemotherapy were classified into 4 groups Viz. people with good/poor pain control on opioid treatment with/ without cannabinoids. They were analyzed for pain control and Quality of Life. Results: There were no major differences in baseline characters. Pain relief, overall qualities of life, weight gain and nausea control was better in cannabis group, when used independently or in combination with opioids. No significant additional side effects pertaining to cannabis were reported. Conclusion: We conclude that conventional herbal medicine- Bhang [cannabis crude form], is effectual in controlling cancer pain efficiently as well as improving QOL. Hence, chemical/medicinal form of cannabinoids could be extracted and cogitated as a prospective scientific study. If scientifically proven, it will be a significant addition to the symptomatic care of terminally ill cancer patients.

Radiation Recall Dermatitis Patterns in Carcinoma Breast: 7-Years Experience of A Regional Cancer Centre of North West India

Dr Akhil Kapoor, Dr Kamlesh Kumar Harsh, Dr Ramesh Purohit, Dr Saroj Kumari, Dr Raj Kumar Nirban, Dr Harvindra Singh Kumar

  1. Dr Akhil Kapoor
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute
  2. Dr Kamlesh Kumar Harsh
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute
  3. Dr Ramesh Purohit
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute
  4. Dr Saroj Kumari
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute
  5. Dr Raj Kumar Nirban
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute
  6. Dr Harvindra Singh Kumar
    Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute

Aim: To study the occurrence of an acute inflammatory reaction following a chemotherapeutic drug administration, in a previously irradiated area. Almost two third cases present with a skin reaction, ranging from mild erythema to marked desquamation. Our purpose was to assess the frequency and severity of radiation recall dermatitis in the breast cancer patients treated previously with radiation. Materials and Methods: Data were collected from 2374 patients who underwent radiation therapy for breast cancer. Follow up was weekly after chemotherapy, then monthly for 3 months, 3 months up to 1 year and later every 6 months. Development of dermatitis during and after completion of radiotherapy was evaluated by the RTOG-criteria. All patients received supportive skin treatment for dermatitis. The inclusion criteria comprised of pathologically proven breast cancer patients treated with modified radical mastectomy followed by chest wall radiotherapy 50Gy in 25 fractions, 2Gy per fraction, five fractions per week for five weeks. Results: Radiation recall dermatitis was reported in a total of 231 patients out of 2374 (9.7%) on administration of different chemotherapeutic drugs. Majority of reactions (194 patients i.e. 81.7%) developed between the 3rd week to 2nd month after chemotherapy. We observed grade-I reaction in 164 patients (71%), grade-II reaction in 56 patients (24.2%) and grade-III reaction in 11 patients (4.8%). All these patients had received chemotherapy after completion of radiation. All cases had good response to topical steroids. At 6 months, the appearance of the skin remained good in all cases. Majority of reactions were due to doxorubicin. Last case in our study developed RRD at 1 year after radiation, with administration of doxorubicin. Conclusion: It is an observational study assessing the frequency and severity of radiation recall dermatitis. Many drugs have been associated with this phenomenon like anthracylines, alkylating agents, antimetabolites etc and even exposure to UV light. The study continues because the interval between the end of radiotherapy and the recall reaction ranges from days to years.

Efficacy of Neoadjuvant Chemotherapy in Locally Advanced Squamous Cell Carcinoma of Esophagus

Dr Humera Mahmood, Dr Mohammad Faheem, Dr Sana Mehmood, Dr Kashif Iqbal, Dr Rafia Toor, Dr Samina Asif, Dr Javaid Irfan

  1. Dr Humera Mahmood
    Consultant Oncologist, Department of Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  2. Dr Mohammad Faheem
    Head, Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  3. Dr Sana Mehmood
    Resident, Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  4. Dr Kashif Iqbal
    Consultant, Oncologist, Department of Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  5. Dr Rafia Toor
    Principal Medical Officer, Department of Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  6. Dr Samina Asif
    Medical Officer, Department of Oncology, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)
  7. Dr Javaid Irfan
    Director, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI)

Esophageal Cancer occurs worldwide and squamous cell carcinoma is the dominant histologic type of esophageal malignancy. Esophageal cancer is an aggressive disease and most of the patients presenting with locally advanced disease die despite surgical removal of tumor. Poor survival rate achieved with surgery alone has led to the evaluation of preoperative chemotherapy in patients with esophageal carcinoma. Several trials are underway evaluating the role of neoadjuvant chemotherapy in locally advanced esophageal cancer. Objective: To determine the efficacy of neoadjuvant chemotherapy in patients with locally advanced squamous cell carcinoma of esophagus. Setting: The study was conducted at Oncology department of Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad. Methods: Patients were evaluated by taking detailed history and doing a complete physical examination, followed by investigations to determine the stage of disease. After an informed consent patients were given 3 cycles of inj Cisplatin and inj 5FU. Response was evaluated 4 weeks after completion of treatment using RECIST criteria. Results: The response rate achieved in this study with neoadjuvant chemotherapy was 63.9 %. Fifty two out of 83 patients (62.7%) had partial response and 1 out of 83 patients (1.2 %) had complete response. Although not statistically significant a trend towards improved response rate was seen in patients with well differentiated tumors and those located in lower thoracic esophagus. Conclusion: Neoadjuvant chemotherapy with inj Cisplatin and inj 5 Fu in locally advanced squamous cell carcinoma of esophagus is potentially useful in downstaging of disease.

Intensive Care For Cancer Patients: An Overview

Dr V Suhag, Dr B S Sunita, Dr A Sarin, Dr A K Singh

  1. Dr V Suhag
    MD DNB Radiation Oncology, Classified Specialist Radiation Oncology
    Army Hospital (Research & Referral)
  2. Dr B S Sunita
    MD DNB Pathology, Classified Specialist Pathology
    Base Hospital
  3. Dr A Sarin
    MD (Radiodiagnosis), DNB Radiation Oncology, Senior Advisor Radiodiagnosis & Radiation Oncology, HOD Radiation Oncology
    Army Hospital (Research & Referral)
  4. Dr A K Singh
    MD Radiodiagnosis and trained in Radiation Oncology, Senior Advisor Radiodiagnosis & Radiation Oncology
    Army Hospital (Research & Referral)

The number of patients living with cancer has been increasing steadily. The ageing population, improved diagnostic tools for cancer, and decrease in cancer-related mortality have contributed to this increase. Intensive chemotherapy regimens and the use of new and more targeted therapeutic drugs have resulted in high cancer cure rates. However, the treatment often leads to drug-related organ toxicities and increased susceptibility to infection. As a consequence, intensivists are increasingly managing patients with cancer who are admitted to the intensive care unit (ICU) for organ dysfunction originating from infectious, malignant, or toxic complications. Managing organ dysfunction in critically ill cancer patients requires specialized skills by the intensivist and close collaboration between the intensivist and oncologist. Outcome of critically ill cancer patients admitted to the ICU has improved; it could be associated with medical advances in critical care, introduction of new anticancer treatments, and better supportive care. Recent reports have described ICU mortality for critically ill cancer patients ranging from 15.9% to 32%. With good reason, oncologists and intensivists reserve ICU admission for select cancer patients with potentially reversible medical conditions and a reasonable prospect of substantial recovery. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer.

Hematological Changes in Oral Cancer Patients with Smoke-able and Chew-able Tobacco

Dr Mirza Arsalan Baig, Dr Saira Baloch, Dr Muhammad Ali Ghoto, Dr Muhammad Muslim, Dr Samrah Baig, Dr Mohsin Ali Baloch

  1. Dr Mirza Arsalan Baig
    Department of Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan.
  2. Dr Saira Baloch
    Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
  3. Dr Muhammad Ali Ghoto
    Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan.
  4. Dr Muhammad Muslim
    Department of Science and Dental Materials, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
  5. Dr Samrah Baig
    Faculty of Pharmacy, Federal Urdu University Karachi, Pakistan
  6. Dr Mohsin Ali Baloch
    Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan.

Objective: To analyze hematological changes in patients of oral cancer with history of smoke able and chewable tobacco use, and to compare them with healthy controls. Study Design: Descriptive type of study survey. Setting: This study was conducted at department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro. Study Period: One year July, 2013 to July, 2014. Subject & Methods: Histo-pathologically confirmed hundred cases of oral cancer with history of smoke able and non-smoke able tobacco were selected to analyze the hematological variation. Inclusion Criteria: Histopathologically diagnosed patients of oral squamous cell carcinoma, with history of smoke able and non smoke able tobacco. Exclusion Criteria: Patient with any systemic medically compromising problem, terminally ill patients, radio or chemotherapeutically treated patients, patients with metastasis to lungs or any distant metastasis, patients with history of more than one well defined etiological factor involved. Results: There were 73% patients of oral cancer reported with anemic. Significantly lower values of Hb, Platelet and higher mean values of ESR, TLC and were observed in both groups of oral cancer patients; tobacco smokers and tobacco chewers as compared to non-smokers healthy controls. There was more decline in the level of haemoglobin and incline in the level of ESR observed in tobacco chewer oral cancer patients as compared to tobacco smokers patients, while TLC was more observed in smokers. Conclusion: Oral cancer patients with history of chewable/smoke able tobacco have likely worse hematological profile, which increases the anesthetic and surgical challenges for maxillofacial surgeons, which have significant impact on treatment planning as well.

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